Recombinomics
CommentaryMay 30, 2006Two additional cases occurred in a
10-year-old girl and her 18-year-old brother from Bandung, West Java.
Both children developed symptoms on 16 May, were hospitalized on 22
May, and died on 23 May. Both children had a history of close contact
with sick and dying chickens at their home in the week before symptom
onset. The identical onset dates strongly suggest that they acquired
their infection following a shared exposure to poultry, and not from
each other. Follow-up of contacts has not identified further cases of
influenza-like illness.

The above description from the WHO
update accurately indicates that the same disease onset date
strongly suggests a common source for the infection of the
siblings. However, most of the human cases in West Java have a novel
HA cleavage site, RESRRKKR, yet that cleavage site has not been
described in birds from West Java (see map).
Therefore, sequence analysis of H5N1 from the siblings, as well as
poultry in the area would be useful.

Recent local reports describe another suspect
familial cluster in an adjacent village in Bandung and three
earlier clusters in the area have been described. Each cluster
had at least one member H5N1 confirmed by Hong Kong. There is
also a geographical cluster in Bekasi,
also in West Java.

The sequences from these earlier clusters shopuld be released immediately.